During the 1990s, the number of people dying as a result of injury from traffic accidents decreased, and suicide became the leading cause of death from injury in Australia.

Australian Health Ministers have identified injury prevention as one of seven National Health Priority Areas, a policy initiative that seeks to focus on diseases and conditions of particular importance for the health of Australians. The focus on injury has arisen because although a greater proportion of Australians now live into old age than at any time in the past, each year significant numbers are hurt or die as a result of injury. Most injuries are not fatal. In 2001, 7,876 Australians died from injury, while 2.25 million people reported being injured over a four-week period in the same year.Injuries not resulting in death range in severity from minor cuts and bruises to permanent impairment and disability. However, an important aspect of both fatal and non-fatal injuries is that many of them are preventable.

Some groups within society, such as the young, the elderly and those employed in certain occupations, tend to be more at risk from injury. For example, injury remains the main cause of death among young people, and, while older Australians are injured at a lower rate than other age groups, they are more likely to die of injury than any other age group. Understanding who is most at risk and the circumstances that surround injuries can assist in injury prevention and management.

Injury-related deaths and recent injuriesThis article draws on data from two sources. Data on injury-related deaths come from the ABS Deaths Collection, which compiles information from death certificates. Data on injuries come from the ABS National Health Survey conducted in 2001.

An injury is a trauma, poisoning, or other condition of rapid onset to which factors and circumstances external to the person contributed significantly. External causes of injury may be physical, chemical or psychological.1 Injuries may be unintentional, for example, as a result of motor vehicle accidents, sporting injuries and accidental poisonings. Some injuries may be intentional, for example, those resulting from assault.

Injury-related deaths are deaths where the underlying cause was determined to belong to the International Classification of Diseases (ICD-10) Category ‘External Causes of Morbidity and Mortality (V01-Y98)’.

Recent injuries are defined as those injuries sustained as the result of an event/accident in the four weeks prior to interview. All injuries which required some treatment or action were covered by the survey, ranging from minor first aid to attendance at a hospital casualty department. Although people could report a large number of such events in the four weeks prior to interview, detailed data were reported for the most recent event only.

Long-term conditions resulting from injury were included in the 2001 National Health Survey. People were asked if any current long-term conditions had been caused by injury. Unlike recent injuries, these injuries may have occurred at any point in a person’s life and were reported only if they resulted in a condition lasting, or expected to last, longer than six months.

Injury-related deaths and recent injuriesIn 2001, the leading cause of death from injury in Australia was suicide, accounting for 31% of all injury-related deaths. Following suicide, transport accidents were the next most common cause of injury-related death, causing 25% of such deaths. This has not always been the case. Between 1971 and 1990, motor vehicle traffic accidents caused more injury-related deaths than suicide. However, over the 30 years to 2001, there was a consistent decline in the age-standardised death rate from motor vehicle traffic accidents (from 30 to 9 deaths per 100,000 population in 2001), while the rate of suicide remained relatively stable (at around 13 deaths per 100,000). In 2001, accidental poisoning and falls each caused 8% of injury-related deaths, while assault caused 4% of injury-related deaths.

In 2001, open wounds and bruises were the most common types of recent injuries reported in the National Health Survey (63% of people reporting recent injuries). Other relatively common injuries were sprains, strains or tears (18% of people with recent injuries), and burns and scalds (6%).

In 2001, low falls (one metre or less) were the leading cause of recent injury. This type of fall injured around 31% of people reporting recent injuries. Collisions or being struck by an object were also relatively common (19% of those injured), and were also the most common event causing concussion (37% of concussed people).

SELECTED CAUSES OF INJURY-RELATED DEATHS - 2001

(a) Includes choking, suffocation, drowning, and many other external causes.

Source: ABS Deaths Collection.

PERSONS WHO REPORTED A RECENT INJURY: SELECTED INJURIES(a) - 2001

(a) Most recent injury in the past four weeks.(b) Includes dislocations, torn muscles and ligaments.

(a) Most recent injury in the past four weeks.(b) Includes recent injuries not specified above.

Source: ABS 2001 National Health Survey.

Effects of injuriesMany injuries have a relatively minor impact on health. For example, of those people reporting a recent injury in 2001, less than 9% attended hospital. While injuries such as fractures and concussions were less common than some other types of injury, they often required a visit to the hospital. In 2001, 55% of people with a fracture and 37% of concussed people attended hospital, compared with 6% of people with open wounds (the most common type of recent injury).

However, injuries may result in longer-term adverse health affects. In 2001, 2.26 million Australians reported a long-term health condition which was due to an injury. The most commonly reported long-term health conditions arising from injury were back or disc problems. These accounted for half (50%) of the people reporting long-term conditions arising from injury. Joint injuries were the next most common type of long-term health condition arising from injury (12%), followed by amputation and knee injuries (each 4%).

(a) Conditions impacting on health for at least six months.(b) Complete or partial blindness.

Source: ABS 2001 National Health Survey.

Who experiences injury?Males of all ages are more likely to die from injury than females. In 2001, the age-standardised death rate from injury for males was 57 per 100,000 population, compared with 21 for females. This partly reflects differences in the behaviour of males and females. For example, in the case of suicide, methods of self-harm typically chosen by males (e.g. hanging or firearms) are generally more lethal than those typically chosen by females (e.g. ingestion of poisons).2While the overall age-standardised rate of suicide remained relatively stable in the 30 years to 2001, the rate among males of all ages generally increased, from around 17 per 100,000 in the mid-1970s to 20 per 100,000 in 2001 (with peak levels of 23 per 100,000 in 1997 and 1998). In contrast, the suicide rate among females declined over the same period (from 10 to 5 per 100,000 population).

AGE-SPECIFIC DEATH RATES(a) FROM EXTERNAL CAUSES - 2001

(a) Age-specific death rate per 100,000 people.

Source: ABS 2001 Deaths Collection.

Males of all ages are also more likely than females to experience injury. Again, this difference reflects differences in the activities in which males and females typically engage, for example in the type of work men and women commonly do. In 2001, the industry that employed the greatest number of full-time male workers aged 15 years and over was the Manufacturing industry, which employed 719,200 men (78% of full-time workers in that industry). Just under 8% of these men reported being injured while working. In contrast, the industry employing the greatest number of full-time female workers in the same age group was the Health and community services industry, which employed over 322,800 women (67% of the full-time workers in that industry). Under 2% of these women reported being injured while working (see also Australian Social Trends 2002, Work-related injuries).

Similarly, because more males participate in organised sport, they are more at risk of sustaining sport-related injuries than females. In 2001, 27% of men participated in organised sport, compared with 20% of women. Boys aged 5-14 years were also more likely to participate in organised sport than girls in the same age group (66% and 52% respectively).3 Overall, males of all ages were more than twice as likely as females to report being injured playing organised sport (3% of males compared with 1% of females). Differences in the type of sports played by males and females may also affect the rate, nature and severity of sporting injuries.

Age-related differences in injury rates are also linked to differences in behaviour and physical characteristics. Young children may have less knowledge of risks and be less able to avoid injury, and young adults are less experienced and tend to take more physical risks than older people (see Australian Social Trends 2002, Selected risks faced by teenagers). In keeping with this, the rate of recent injury was highest among children aged 0-14 years (18%) and people aged 15-24 years (17%), and lowest among older Australians aged 65 and over (6%). However, the rate of injury-related death was highest among older Australians, reflecting their physical vulnerability when injured.

RATES(a) OF RECENT INJURIES BY AGE - 2001

(a) Rate per 1,000 people.

Source: ABS 2001 National Health Survey.

Although young people are less likely to die from injury than older people, injury accounts for the greatest number of deaths among people aged 15-24 years (79% of all deaths among men, and 60% of deaths among women in this age group in 2001). This is partly because young people are less likely than older people to die from other causes, such as health conditions that may develop over long periods of time (e.g. cancers and heart disease - currently the leading overall causes of death in Australia).

People of different ages also experience and die from different kinds of injuries. Children aged 0-14 years were more likely to die from drowning or other accidental threats to breathing, such as choking, suffocation and strangulation (31%), and in transport accidents (37%), than from other causes of injury. Of all types of recent injuries, children in this age group were most likely to be injured in low falls (53%), or from collisions or being struck by an object (14%).

More people aged 15-24 years died in transport accidents than from other causes of injury (45% of all injury-related deaths experienced by this group), while the most common recent injuries in this age group were from low falls, or from collisions or being struck by an object (22% and 23% respectively). While suicide was a major cause of death for young people aged 15-24 years (30% of all injury-related deaths in this age group), the suicide rate was highest among people aged 25-34 years (21 per 100,000 population) in 2001. This age group was also more likely to die from suicide than other causes of injury (43% of injury-related deaths).

Falls made up a higher proportion of injury-related deaths for people aged 65 years and over, than they did for other age groups. This group was also more likely to be injured from a fall than from other types of injury.

Circumstances of recent injuriesInformation about the locations in which injuries occur, and about the activities people are undertaking at the time of injury can assist in managing the risk of injury in the community. In 2001, injuries most commonly occurred in people’s homes - their own or someone else’s (46% of all people reporting recent injuries). The most common type of injury in and around the home was an open wound, such as a cut which could occur from a sharp knife or tool (45% of those people injured in and around a home).

The next most commonly reported location for injury to have occurred in 2001 was at a sports facility or athletics field or park (15% of people reporting recent injuries). The most common type of injury reported at this location was a dislocation, sprain, or strained or torn muscle or ligament. Over three-quarters (77%) of people injured at a sports facility, field or park sustained the injury participating in organised sport. A further 17% of these people were injured using these areas informally for leisure.

PERSONS WHO REPORTED A RECENT INJURY: LOCATION OF INJURY(a) - 2001

a) Most recent injury in the past four weeks.

Source: ABS 2001 National Health Survey.

Of a range of activities associated with recent injuries, most people were injured during their leisure time (26% of people reporting recent injuries). Working for income was the next most common activity associated with injury (21% of people of all ages reporting recent injuries), followed closely by domestic activities (20% of those injured) and organised sport (15% of those injured).

In 2001, the majority of people reporting a current long-term condition arising from injury, sustained that injury at work or school (1 million people, or 46% of people with an injury-related long-term health condition), with most of these injuries being work-related (79%). Injuries from motor vehicle accidents or sport or exercise participation also left large numbers of people with a long-term health condition (495,300 and 545,200, respectively).

The consumption of alcohol at high levels (i.e. an average of more than five standard drinks per day for men or more than three standard drinks per day for women) is a well known contributing factor in a range of health conditions.4 In addition, there is an association between alcohol consumption and the risk of injury.5 In 2001, the likelihood of people reporting an injury increased with the risk level of their drinking. For example, 6% of non-drinkers reported an injury in the four weeks prior to interview, compared with 15% of high risk drinkers. People who drank at risky or high risk levels were more than twice as likely to report a high fall than were people who didn’t drink or who drank at a low risk level. They were also more than five times as likely to have been injured as a result of being attacked.

ALCOHOL RISK(a) AND PROPORTION OF PEOPLE(b) INJURED - 2001

(a) Risk categories refer to alcohol-related harm in the long-term (i.e. if levels of daily consumption were maintained). Low risk drinking is up to 4 standard drinks per day for men, and up to 2 standard drinks per day for women. Risky drinking is 5 to 6 standard drinks per day for men and 3 to 4 per day for women. High risk drinking is 7 or more standard drinks per day for men and 5 or more for women.(b) Age standardised.